Prescription Safety Eyewear Program

Transcription

1 US Airways Employees Represented By The International Association Of Machinists (District 142) Prescription Safety Eyewear Program Dear US Airways Employees Represented by the IAM, Your eyesight is important to you, your family and to US Airways and your union. In addition to non-prescription safety eyewear provided at no cost, you have the opportunity to purchase prescription safety glasses for $16.50 per pair (payroll deducted or credit card). You provide the prescription at your cost. You also have the ability to purchase additional lens and frame options and pay only for the option(s) you choose. To take advantage of this benefit, please follow the instructions in this booklet, provided by Hi-Tech Optical. Additional information and the complete prescription safety eyewear policy can be found in the MPPM, BASIC Package Includes: ($16.50) Safety Lenses, Plastic or Polycarbonate (polycarbonate lenses will be provided unless standard plastic is specified) Single Vision Bifocal D-28 Trifocal Scratch Coating for Plastic Lenses Carrying Case Side Shields-Permanent or Clip On (clip on are provided unless permanent are specified) You choose your BASIC Package frames from 18 Frame styles Departments that receive the BASIC Package without charge: 464M Machine Shop 454W Weld Shop 485 Plant Maintenance Additional Lens Options (employee expense): Progressive Lens (Outlook) $ Premium Progressives (Varilux, Panamic, Kodak, Compact) $ Tints $ 4.00 Ultraviolet Protection (plastic lenses) $ 7.50 Anti-reflective Coating $ Hi Index Lenses $ Transitions $ Dual Segs (Occupational) $ Optical Services Provided by: Additional Frame Options (employee expense): The frame styles pictured in this booklet are available as part of the BASIC Package. Optional frame styles are listed at the end of this booklet, along with the additional cost. Frames that are available from Titmus and On- Guard are pictured on the Frame Posters. See your administrator for details or go to the Safety Equipment web page from Wings. This booklet, the order form and the Titmus and On-Guard frame charts are found on the Safety Equipment web page. Revision: April

2 Ordering Process 1. Obtain Order Form (Safety Equipment web page or program administrator). 2. Select Safety Frame - a selection of sample frames are located with the program administrator in the following stations: CLT - Line Mtc office at terminal PHL - Mtc office at terminal PHX - IAM office at hangar PIT - Mtc Administration All other stations - call or Ron Miller ( or ron.miller@usairways.com) and a sample kit will be sent for your use and return. 3. Eye Examination - take frame to appointment for measurements: *PD (measurement of the distance between your pupils) necessary for all prescription orders. *Seg Height (measurement used to determine placement of reading segment in lens) this measurement is necessary for multifocal wearers only. 4. Return completed and signed order form, Rx and safety frame to your program administrator. 5. Program Administrator will fax your order form and Rx to Hi-Tech Optical. 6. Your Prescription Safety Eyewear will be returned to your house or place of work within 10 days. OG92 Sizes: ; OG93 Sizes: ; OG95 Sizes: ; ; OG94 Sizes: ; Basic Package Frames OG69 Sizes: ; ; OG ; OG34S Colors: Brown, Grey, Demi Amber, Blue/Mauve OG71 Sizes: ; ; ; OG70 Sizes: ; ; ; OG

3 Upgrades Additional Frame Options at Employees Expense: (Payroll Deducted) $18.00 Upgrade: FC- 703, 705, 706, 707, 709, 710 OG-10, 16, 17, 19, 31, 32, 42, 90, 103, 112, 113, F Colors: Gray, Black Sizes: ; 48.22/24.145; ; Uvex Astro Rx3003 Colors: Blue, Black Sizes: One Size SP83/SP83BF w/ cup shield Colors: Brown, Gray Sizes: ; ; / SP83BF: ; SC900 w/ standard temple Color: Brown, Smoke, Tan Sizes: ; ; SC901 w/ integral shield Sizes: ; Upgrade: PC-8A, 261, 264, 266, 267, 268, 269, 280, UVEX XC w/ RX Insert BC-101, 102, 104, 109, 115, SW06 OG-18, 30, 31C, 35, 36, 45, 45P, 53, 56, 65 OG- 72, 80, 81, 82, 84, 86(w/o clip), 87, 90, 133, Upgrade: PC-250, 250SW, TR-301S, 302S, 303S, 304S, 305S, 306S, 307S, TR-308S, 309S, 310S OG-86(w/clip), 88, 96, 108, 115, 116, 125, 126, 132, 132S, 133,135, 301, 307, 309NP, OG-310, 310NP, 311, 312 OG-313, 314, 317, 318, 321, 322 $43.00 Upgrade: EX-259, 275S, SW02, SW03 OG-314(w/clip), 138, 138S.00 Upgrade: EXT-2, 4, 5, 6, 7, 8, 9, 10, EXTS-1, 2, 3 OG-58, 60, 76, 77, 83, 97, 98, 99,109, 110, 111, 122, 124, 130 OG- 130S, 140 To view additional frames visit the links below SC2000 w/ standard temple SC2000S w/ integral shield Colors: Tan Sizes: ; ; FC601A Colors: Goldtone, Pewter Sizes: ; ; Titmus OnGuard For further information visit FC702 Colors: Gray, Brown Sizes: ; ; FC704 Colors: Brown, Gray Sizes: ;

4 Contact Information Sales Representative - Diana Davis Hi-Tech Optical s Contact Information PHONE: Customer Service FAX: Customer Service Customer Service Christy Way Saginaw, MI Visit Our Website

5 3139 Christy Way Saginaw, MI FAX Account #: Employee Name & ID #: Company Information Ship to Information Bifocal (visible line) $16.50 name: US Airways Ship to Company: << check box if shipping to Company or fill in employee's address below Trifocal (visible double line) $16.50 phone # address Dual Segs (2 reading segs) $30 Company authorization for payment of Basic Package (Machine Shop, Plant Maintenance, Weld Shop) 2347 $16.50 Progressive (no visible line) $62 city, st & zip Prog Upgrade (Varilux) $87 Date: Lens & Frame Option Costs Single Vision Employee Pays Total Due Authorized Signature: phone # Frame Cost (below) Payment Options: (check option) Payroll Deduction or Check or Credit Card (fill information in below) Payroll Deduction Signature: Checks should be made payable to Hi-Tech Optical and submitted with order form Additional Charges: Lens Seal Scratch 1yr war $15 Tints Brown Gray $4 Transition Bro. Gra. $50 AMX VISA Master Card Discover (Circle One) Credit Card # Sec. Code Anti Reflective (no glare) $30 Signature: Exp. Date: Zip Code: 3 digits on back Total Due = Frame Sizing Information: Frame # & Cost SC900 Frame Picture Example: size *measurement is in mm (mila meters) 56 = the distance straight across the lens 17 = the bridge width 135 = the length of the temple Check the frame, color and size you would like to order below. *size highlighted in bold indicates sample size provided Colors Sizes Frame # & Cost PD Measurement > Frame Picture Measurements Needed!! PD - distance between pupils. On your Rx or request from eye care provider. May be listed as 1 or 2 #'s (ex. 61 or 31 & 30) Colors Seg Height > needed for all multi focal lens orders bring frame to eye care provider and request seg ht Sizes Brown Antique Brown Smoke PC268 Chrome Tan OG91 Gold Gray Gunmetal TR301S Brown SC2000 SC2000S SP83/ SP83BF FC705 $18 Tan Gray TR302S Brown Burgundy Brown Gray Gray TR303S Brown Brown Rose TR304S Gray Gray Antique Brown FC707 $18 Antique Brown Brown Dark Gunmetal TR309S Gray Violet BC104A Goldtone Gray Gunmetal TR310S Green Violet BC109 BC115 Antique Gold Blue Venom Demi Amber SW02 Gray Demi Red $43 Tumbleweed Adobe Brown Dark Bronze Brown Dark Steel EXT8 Steel Burgundy SW06 Brown/Orange Dark Brown Black/Yellow Dark Gray Clear/Black/ Yellow EXT9 PC264 Gunmetal Light Brown Antique Goldtone Light Gray Antique Brown EXTS1 PC266A Tortoise/Blue Black/Tortoise REMEMBER TO: 1. Fill in Employee Name & ID # 2. Select Frame, Size & Color 3. Call or visit your Eye Care Provider for Rx & Measurements 4. Fill in the Payment Method section above 5. Check if completed glasses are to ship to company or employee's home 6. Return Frame and Form to your Program Administrator 7. Fax Completed Order Form and Employee's Rx to Hi-Tech Optical THANK YOU FOR YOUR ORDER Hi-Tech Optical Customer Service # Fax #